Authorised Representative Form

Energy On customers can appoint an Authorised Representative to liaise with us on your behalf. This can include a financial counsellor or someone who helps you manage your energy bills. When you appoint an Authorised Representative, you are giving the person you appoint the authority to act on your behalf as your agent, which may include making account enquires, changing account details, setting up a payment plan, providing feedback or a complaint or terminating a contract.

You can specify limitations of your Authorised Representative’s rights and appoint up to three Authorised Representatives. Please contact us on 1300 323 263 if you require further assistance in completing this form.If English is not your first language and you require assistance you can speak to the Translating and Interpreting Service (TIS). Contact the TIS directly on 131 450, this service is accessible anywhere in Australia at no cost to you.

Authorised Representative Details

Authorised Representative’s full name *

Authorised Representative’s date of birth *

Relationship to Account Holder *

Authorised Representative’s telephone number *

Authorised Representative’s email address *

Authorised Representative’s physical address *

Account Holder Details

Account Holder's Full Name *Note: You must be the account holder to appoint an Authorised Representative

Account / Customer Number *

Email Address *

I, the Account Holder, wish to appoint the following person as my Authorised Representative *

Appointment limitations for the Authorised Representative Note: Specify anything that your Authotised Representative should NOT be allowed to do on your behalf. If left blank, the Authorised Representative has the power to act as if they were you.

By completing this form: I understand I am giving the person appointed here, the authority to act on my behalf as my agent, which may include making account enquiries, changing account details, setting up a payment plan, providing feedback or a complaint or terminating a contract. *

Date *